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The Menopause Exchange Blog


There are many reasons why you may be feeling tired, such as after an illness, extreme activity or acute stress. When doctors use the word ‘fatigue’, they mean overwhelming, prolonged and often- unexplained tiredness, not relieved by good sleep and rest.

This article was included in issue 79 (winter 2018/2019) of The Menopause Exchange newsletter.

Causes of fatigue

There are many causes of fatigue; some of these may be related to the menopause and others can occur at any age.
Sleep disorders. Hot flushes and night sweats due to the menopause may disturb your normal sleep pattern, leaving you feeling unrefreshed in the morning. Sleep apnoea (when your throat narrows) may be due to getting older or putting on weight; as your blood oxygen levels fall, your sleep is interrupted and is of poor quality. Anxiety and depression may cause difficulties in falling sleep, frequent waking with nightmares or vivid dreams and early morning waking with difficulty falling asleep again. Other age-associated causes of poor sleep include restless legs, indigestion and back or joint pains.
Anaemia. Anaemia can be a common cause of tiredness and has many forms. Iron-deficiency anaemia may occur from abnormal bleeding, such as perimenopausal heavy periods, or other bleeds such as haemorrhoids. Vitamin B12 deficiency anaemia (‘pernicious anaemia’) may be caused by an immune reaction. It becomes more common from middle age, often coinciding with the menopause.
Coeliac disease is an immune reaction to gluten, which is a plant protein in the diet. It affects absorption and can cause diarrhoea and weight loss. Coeliac disease is increasingly recognised as a problem later in life as well as in the young. It’s diagnosed with a blood test and managed with a gluten-free diet.
Vitamin and mineral deficiencies, such as vitamin D, iron, zinc, B vitamins, can be hard to diagnose but may result from low levels in food or poor dietary habits.
Underactive thyroid. Thyroid disorders are very common at, and following, the menopause, possibly affecting one in three women. Most women will have an underactive thyroid, causing tiredness, aching, slowness, dry skin and hair and weight gain, although an overactive thyroid can also cause tiredness. Thyroid disorders are easily diagnosed with thyroid function blood tests and are often treated with thyroid hormones.
Type 2 diabetes. This becomes more common as people get older. In some people, it’s linked with being overweight and not being active enough, although simply ageing of the pancreas will cause insulin resistance and eventual high blood sugar levels. Although not directly related to the menopause, type 2 diabetes often develops at the same time as the menopause and is affected by hormone balance. Common symptoms include thirst, urinary frequency and tiredness. Management begins with diet and increased activity, but it’s a progressive condition and most people end up taking medication as well.
Depression and anxiety. These are well-recognised associated symptoms of the peri-menopause. Tiredness and aching can also result from increased muscle tension, even if sleep is good. Chronic fatigue syndrome (myalgic encephalomyelitis, ME). This is poorly understood and difficult to diagnose, as there are no specific tests. It can be severe and disabling, causing a range of symptoms, especially fatigue, muscular pain and poor memory or concentration. It’s most common in young adults but can occur in later life, including at the menopause. Management options for CFS/ME include a healthy diet, a structured exercise programme, cognitive behavioural therapy (CBT) and medicines to relieve the symptoms.
Overindulging. A poor diet (especially high carbohydrate intake), inactivity and drinking too much alcohol will lead to a cycle of tiredness and poor sleep. The recommended limit for alcohol is 14 units a week, spread over the week but with some alcohol-free days.

Self-help strategies

Nutrition. There’s no substitute for a well-balanced diet with plenty of fresh fruit and vegetables, protein and vitamins (such as from meat and fish) and energy from slow release carbohydrates, such as grains, nuts and pulses. However, there’s some evidence that our soil is deficient in many minerals including iron and zinc, and a general multivitamin and mineral supplement may be useful. It’s best to avoid high levels of sugary carbohydrates, which will affect blood sugar levels.
Exercise. Even if you’re experiencing fatigue, a gentle programme of gradually increasing exercise will improve your symptoms and maintain muscle bulk and core strength. The Department of Health recommends at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity. Strength training can prevent the slow decline of muscle wasting that occurs when people age. Find an activity you enjoy (such as walking, swimming and cycling) and gradually increase your duration or effort every week. Your sleep, mood and digestion will also improve.

Management approach

If you still feel fatigued after you’ve improved your lifestyle, speak to your GP. They should examine you and recommend some blood tests to exclude serious causes. Blood tests may include a full blood count and ferritin (iron stores) to rule out anaemia, liver, kidney and thyroid function tests, blood sugar and vitamin levels (such as vitamin D, B12 and folate), and anything else they feel is necessary. If these are all normal, take a multivitamin and mineral supplement and, if your sleep is affected, try medicines to help you sleep. Complementary therapies may help you relax. Some people can be prescribed melatonin to improve sleep patterns.

HRT for fatigue

HRT may help with tiredness, especially if you aren’t sleeping well because of night sweats or muscle aches. So if your menopausal symptoms are making you generally more tired, anxious or tense, it may be worth trying HRT.

About the author
Dr Gill Jenkins is a GP in Bristol, with a particular interest in lifestyle changes to improve health and is also a travel medicine specialist (in repatriating patients who have been taken ill abroad).

Created Winter 2018/2019

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